After School Meals Program Application
You will receive an email of approval once your principal and foodservice manager have signed the application
Select Program Type *
Current Date *
MM
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DD
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YYYY
Are You a "PiggyBack Program?" *
Only one program needs to be on file with the nutrition department at each school site for each meal type, but we require all programs to fill out this application in order to properly forecast meal numbers to produce (snack or dinner). If there is already a program at your school receiving snacks or dinners, check yes below. If you are the first program that you are aware of select, No.
School *
After School Program Name *
Your answer
Program Coordinator *
Your answer
Coordinator Phone Number *
Your answer
Coordinator Email *
Your answer
Bill to: *
(Provide building fund or internal account number. If area eligible, program would only be billed in the event that snacks ordered were not picked up or unused snacks not returned.
Your answer
Number of Student Attending *
(A roster will need to be submitted once your application is reviewed. Any changes will need to be communicated to cafeteria manager 24 hours prior)
Your answer
Start Date *
MM
/
DD
/
YYYY
End Date *
MM
/
DD
/
YYYY
Program Days *
Check all that Apply
Required
Program Hours *
(Your cafeteria site manager will establish a drop off time or meal service time if necessary)
Your answer
Will Non-Program Students Be Receiving Meals? *
(RCNS is able to provide snacks to all students 18 years and under on school campus in addition to your program students, fill out number additional students below):
Total Count for Additional Non-Program Students Receiving Meals? *
(If the count ever changes this must be communicated to the cafeteria):
Your answer
Describe the Educational or Enrichment Activity of your Program (required by DOE for participation in meal services) *
Your answer
Questions or Comments
Your answer
Submit
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